Time Costs for Genetic Counseling in Preconception Carrier Screening with Genome Sequencing

Advances in technology and the promise of personalized health care are driving greater use of genome sequencing (GS) for a variety of clinical scenarios. As health systems consider adopting GS, they need to understand the impact of GS on the organization and cost of care. While research has documented a dramatic decrease in the cost of sequencing and interpreting GS, few studies have examined how GS impacts genetic counseling workloads. This study examined the time needed to provide genetic counseling for GS in the context of preconception carrier screening. Genetic counselors prospectively reported on the time spent in the results disclosure process with 107 study participants who were part of the NextGen study. We found that the median time for results disclosure was 64 min (ranged from 5 to 229 min). Preparation work was the most time-consuming activity. Qualitative data from journal entries, debrief interviews with genetic counselors, and detailed case conference notes provided information on factors influencing time for results disclosure and implications for practice. Results suggest that expanded carrier screening could require significant increases in genetic counseling time, unless we are able to generate new resources to reduce preparation work or develop other strategies such as the creation of new models to deliver this type of service.     

Relationship of Mindfulness to Distress and Cortisol Response in Adolescent Girls At-Risk for Type 2 Diabetes

Altered stress response theoretically contributes to the etiology of cardiometabolic disease. Mindfulness may be a protective buffer against the effects of stress on health outcomes by altering how individuals evaluate and respond to stress. We engaged adolescent girls at risk for developing Type 2 diabetes in a cold-pressor test in order to determine the relationship of dispositional mindfulness to cortisol response and subjective stress, including perceived pain and unpleasantness during the stressor, and negative affect following the stressor. We also evaluated mindfulness as a moderator of psychological distress (depressive/anxiety symptoms) and stress response. Participants were 119 girls age 12–17 years with overweight/obesity, family history of diabetes, and mild-to-moderate depressive symptoms. Greater mindfulness was associated with less perceived pain and negative affect, but was unrelated to cortisol response to the stressor. Regardless of mindfulness, greater depressive/anxiety symptoms related to a more blunted cortisol response. Mindfulness might promote better distress tolerance in adolescents at risk for diabetes by altering how youth perceive and relate to acute stress, rather than through altering the physiological stress response. At all levels of mindfulness, depressive/anxiety symptoms relate to greater blunting of cortisol response. Findings contribute to emerging literature on the role of mindfulness in promoting the mental and physical health and well-being of individuals at risk for Type 2 diabetes.     

The im-materiality of urban religion: towards an ethnography of urban religious aspirations

In recent years, scholars from a wide variety of disciplines have engaged in the study of urban religion. Taken together, these studies form a paradigm that intertwines (1) the politics of belonging, (2) regimes of space and territoriality, (3) materiality and sensorial power and (4) visibility. We argue that while scholars have conceptualised these aspects in very nuanced ways, there is a need to address in a more rigorous way immaterial dimensions of urban religion. We encapsulate these immaterial dimensions in the notion of ‘urban religious aspirations’, meaning the multiple ideational sources that underpin people’s religious investments in urban life. We illustrate the relevance of studying aspirations with an ethnographic example of two Hong Kong Christian women and their involvement in the Umbrella Movement. Exploring their narratives demonstrates the need to take immaterial aspects of religious life into account when researching urban religion, especially in contexts where the distinction between the religious and the secular is less clearly defined.     

Associations Between Dopamine D2 Receptor (<Emphasis Type="Italic">DRD2</Emphasis>) Gene,Maternal Positive Parenting and Trajectories of Depressive Symptoms from Early to Mid-Adolescence

Using data from the Longitudinal Study of Chinese Children and Adolescents (LSCCA), this study is the first to examine the roles of the dopamine D2 receptor (DRD2) gene polymorphisms (i.e., TaqIA and A241G) and maternal positive parenting at ages 10 and 11 years in the trajectories of depressive symptoms from early to mid-adolescence (ages 11 to 16 years). In a sample of 1090 Chinese adolescents (50% girls), three trajectories of depressive symptoms were identified: (i) low-stable (36.1%), (ii) moderate-increasing (44.5%), and (iii) high-increasing (19.4%). A241G AA homozygotes and youth exposed to lower levels of maternal positive parenting were both at increased odds to follow the high-increasing vs. low-stable trajectory. Moreover, the A241G polymorphism interacted with maternal positive parenting to distinguish the moderate-increasing trajectory from the high-increasing and the low-stable trajectories. For A241G G-allele carriers, but not AA homozygotes, exposure to high quality of maternal parenting decreased the odds to follow the high-increasing vs. moderate-increasing trajectory of depressive symptoms. For AA homozygotes, but not G-allele carriers, high quality of maternal parenting increased the odds to follow the low-stable vs. moderate-increasing trajectory. The DRD2 TaqIA polymorphism had neither a direct nor an interactive effect with maternal positive parenting on trajectory membership. The current findings highlight the importance of investigating gene-by-environment interactions (G × E) in trajectories of depressive symptoms over adolescence, and support a developmental versus static nature of G × E effects.     

AIDS and intimate relationships: Adolescents’ knowledge and attitudes

The knowledge level about HIV/AIDS among American adolescents aged 16 to 19 has been assessed on several occasions, showing that in recent years their knowledge base has improved. The knowledge bases of British adolescents and of adolescents younger than 16 have been largely ignored. In attempting to assess the likely impact on present or future behaviors of increasing adolescents’ knowledge base about AIDS it is important to also know something of adolescents’ attitudes to intimate relationships and to sex within those relationships. Previous studies have not linked these two aspects. In this study two hundred London schoolchildren aged 14 and 15 years completed a questionnaire tapping both their knowledge about HIV infection and its transmission and their attitudes to intimate relationships. Their answers revealed that they had absorbed the simple media messages about AIDS, that it kills and that use of a condom during sex offers protection. However they were less well informed on detailed aspects of prevention, although, worryingly, they believed that they knew all that they needed to about preventive measures. The majority had attitudes to intimate relationships that were compatible with the message of restricting their number of sexual partners; however, a significant minority did not. The latter were more likely to deny the risk associated with promiscuity. It is suggested that school-based AIDS education programs should help individuals to develop new attitudes to intimate relationships that are compatible with risk avoidance.